A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis

• Published in: Journal of the American Academy of Dermatology 2013-05, Vol.68 (5), p.765-773
• Main Authors: Pariser, Robert J., MD, Paul, Joan, MD, MPH, Hirano, Stefanie, MD, Torosky, Cyndi, MD, Smith, Molly, MD
• Format: Article
• Language: English
• Subjects: Adalimumab; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - adverse effects; Biopsy; Dermatology; Double-Blind Method; efficacy; Female; Humans; Male; Middle Aged; Placebos; Quality of Life; safety; sarcoidosis; Sarcoidosis - drug therapy; Sarcoidosis - pathology; Skin Diseases - drug therapy; Skin Diseases - pathology; treatment; Treatment Outcome; tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2012.10.056

Background Many medications, including tumor necrosis factor antagonists, have been anecdotally reported to be effective in treating cutaneous sarcoidosis, but controlled study is lacking. Objective We sought to determine if adalimumab is a safe and effective treatment for cutaneous sarcoidosis. Methods Adalimumab or placebo was administered to 10 and 6 patients, respectively, in double-blind, randomized fashion for 12 weeks, followed by open-label treatment for an additional 12 weeks, followed by 8 weeks of no treatment. Assessments were made of cutaneous lesions, quality-of-life issues, laboratory findings, pulmonary function, and radiographic findings. Results At the end of the 12-week, double-blind phase, there was improvement in a number of cutaneous findings in the adalimumab-treated patients (group 1) relative to placebo recipients (group 2), most notably in target lesion area ( P  = .0203). At the end of the additional 12-week open-label phase, significant improvement relative to baseline was found for target lesion area ( P  = .0063), target lesion volume ( P  = .0225), and Dermatology Life Quality Index score ( P  = .0034). No significant changes were seen in pulmonary function tests, radiographic findings, or laboratory studies. After 8 weeks off treatment, there was some loss of this improvement. Limitations Standardized, validated measures for cutaneous sarcoidosis are lacking. There may be observer bias in the open-label portion of this study. The small size of this study makes it difficult to generalize results. Conclusions Adalimumab, at the dose and duration of treatment used in this study, is likely to be an effective and relatively safe suppressive treatment for cutaneous sarcoidosis.